POS1452 EFFECT OF PHYSICAL ACTIVITY ON CHRONIC FATIGUE IN RHEUMATOID ARTHRITIS PATIENTS
Authors: A. Aleksandrov, M. Nikitin, V. Aleksandrov, N. Aleksandrova
Journal: Annals of the Rheumatic Diseases (2022)

Objectives To evaluate the dynamics of fatigue indices in RA patients depending on the intensity of physical activity (aerobic exercise) in the short term. Methods The study included 111 women with RA (mean age 54.4±11.03 years old, mean disease duration 11.9±9.3 years, DAS28-ESR score 2.84 [2.32;3.05]; mean VAS fatigue score 71.6±8.93). All patients underwent a 3-week post-hospital rehabilitation program (PHRP), and aerobic exercise was the main component of this program (dosed walking, daily, up to 1 hour) and outdoor walks up to 3-3.5 hours per day [1].The level of fatigue was estimated using the British Rheumatoid Arthritis Fatigue Scale - Numerical Rating Scale (BRAF-NRS V2). The 50-meter walking test was used to assess the functional state of patients in dynamics, the 6-minute walking distance test (6MWD) - to assess patients’ tolerance to physical activity. The intensity and duration of exercise were compared with serum levels of free fatty acids (FFA), triglycerides (TG), and angiopoietin-like protein type 4 (ANGPTL4), an inhibitor of lipoprotein lipase, which plays an important role in the regulation of lipid metabolism and energy balance. Results After completion of PHRP, RA patients showed a significant decrease in fatigue aspects of the NRS severity scale (6.83 ± 1.21 vs. 6.51 ± 1.18 points, p=0.003), NRS-effect (6.24 ± 1.07 vs. 5.95 ± 1.08 points, p=0.037); a decrease in time taken to complete the 50 m. walk test was noted (79.3 ± 8.64 vs. 78.91 ± 8.15, p=0.01) [2]. Increased concentration of ANGPTL4 (p&lt;0.02), FFA (p&lt;0.01) and decreased TG level (p&lt;0.05) were also determined in serum of RA patients. There was a significant correlation between ANGPTL4 and FFA (r=0.54, p&lt;0.02), but not with TG (r= -0.18, p&gt;0.05). The increase in serum ANGPTL4 during exercise may be mediated by increased serum FFA content and increased lipid oxidation processes. Previously, it was shown that muscle tissue, along with liver and adipose tissue, significantly affect to the increase in circulating ANGPTL4 during exercise [3, 4]. Based on the results of the first phase of the study, patients (n=102) were retrospectively divided into two groups: Group I (n=53) included patients with &lt; 5-6 thousand steps/day (sedentary lifestyle); Group II (n=49) included patients with ≥ 7-8 thousand steps/day (mobile lifestyle).Group II of RA patients significantly improved their physical parameters - reduction of walking time (p&lt;0.001) and number of steps in the 50-meter test (p=0.013) at the end of PHRP. There was a reduction in fatigue severity on all scales: VAS (p&lt;0.001), NRS severity (p&lt;0.001), NRS effect (p&lt;0.001), and NRS-overcoming (p=0.001). In group I, there was an increase in VAS fatigue (p=0.008) and NRS effect (p=0.01). No intergroup differences were found among lipid metabolism indices before and after PHRP (p&gt;0.05). Conclusion Aerobic exercise (walking) is an effective method of increasing physical activity and reducing fatigue in patients with RA during the post-hospital rehabilitation phase. Increased physical activity during walking (≥7-8 thousand steps/day) has a positive effect on physical indices and fatigue components in the short term. Lipid metabolism markers can be used in determining the degree of activity, optimization of the duration and intensity of exercise in RA patients. References [1]Cherkashina IV et al. Vopr Kurortol Fizioter Lech Fiz Kult . 2016;93(2):13-16. [2]Aleksandrov AV et al. Ann Rheum Dis . 2021;80(S1):160-161. doi: 10.1136/annrheumdis-2021-eular.3211 [3]Norheim F et al. Physiol Rep . 2014;2(8):e12109. doi: 10.14814/phy2.12109. [4]Ingerslev B et al. Mol Metab . 2017;6(10):1286-1295. doi: 10.1016/j.molmet.2017.06.018 Disclosure of Interests None declared